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Objetivo: identificar os fatores associados à visita à emergência ou hospitalização dos pacientes oncológicos em cuidados paliativos domiciliares. Método: revisão integrativa nas bases PubMed, LILACS, Web of Science e Embase. Perguntou-se "quais os fatores associados à visita a serviços de emergência ou hospitalização de pacientes oncológicos em cuidados paliativos domiciliares?". Descritores foram neoplasias; cuidados paliativos; hospitalização; serviços médicos de emergência; serviços de assistência domiciliar. Critérios de elegibilidade foram texto na íntegra; entre 2012 e 2022; idioma inglês, português ou espanhol; idade adulta. Resultados:foram selecionados 16 artigos. As causas mais comuns de visita à emergência/hospitalização foram dor, falta de ar, infecção, sintomas digestivos, delirium e queda do estado geral/fadiga. Conclusão: este estudo identificou lacunas em que os cuidados paliativos domiciliares podem ser aprimorados.

Objective: to identify the factors associated with the emergency visit or hospitalization of cancer patients in palliative home care. Method: integrative review in PubMed, LILACS, Web of Science and Embase. The question was "what factors are associated with visiting emergency services or hospitalization of cancer patients in palliative home care?". Descriptors were neoplasms; palliative care; hospitalization; emergency medical services; home care services. Eligibility criteria were full text; between 2012 and 2022; English, Portuguese or Spanish language; adulthood. Results: 16 articles were selected. The most common causes of emergency room visits/hospitalization were pain, shortness of breath, infection, digestive symptoms, delirium, and poor general condition/fatigue. Conclusion: this study identified gaps in which palliative home care can be improved.

Objetivo: identificar los factores asociados a la visita a urgencias u hospitalización de pacientes oncológicos en cuidados paliativos domiciliarios. Método: revisión integrativa en PubMed, LILACS, Web of Science y Embase. La pregunta fue "¿qué factores se asocian con la visita a los servicios de emergencia o la hospitalización de pacientes oncológicos en cuidados paliativos domiciliarios?". Descriptores fueron neoplasias; Cuidados paliativos; hospitalización; servicios médicos de emergencia; servicios de atención domiciliaria. Los criterios de elegibilidad fueron texto completo; entre 2012 y 2022; idioma inglés, portugués o español; edad adulta. Resultados:se seleccionaron 16 artículos. Las causas más comunes de visitas a la sala de emergencias/hospitalización fueron dolor, dificultad para respirar, infección, síntomas digestivos, delirio y mal estado general/fatiga. Conclusión: este estudio identificó brechas en las que se pueden mejorar los cuidados paliativos domiciliários.

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OBJECTIVE: This study aimed to investigate the completion rates of a home-based randomized trial, which examined home-based high-intensity respiratory muscle training after stroke compared with sham intervention. MATERIALS AND METHODS: Completion was examined in terms of recruitment (enrolment and retention), intervention (adherence and delivery of home-visits) and measurement (collection of outcomes). RESULTS: Enrolment was 32% and retention was 97% at post-intervention and 84% at follow-up. Adherence to the intervention was high at 87%. Furthermore, 83% of planned home-visits were conducted and 100% of outcomes were collected from those attending measurement sessions. CONCLUSION: This home-based randomized trial demonstrated high rates of enrolment, retention, adherence, delivery of home-visits, and collection of outcomes. Home-based interventions may help to improve completion rates of randomized trials.

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Since 1996, the Hospital del Tórax Dr. Antonio A. Centrángolo conducts a pulmonary rehabilitation program that requires patients with chronic pulmonary disease to attend the hospital twice a week. In 2015 the home-based program (HBP) was developed for patients living more than either 10 km or 60 minutes away from the hospital, or with conflicting working schedules. A retrospective study was conducted to describe the adherence to the home-based program by patients with chronic pulmonary disease, and explore adherence-related factors. In 2017, 96 (75.6%) of 127 patients eligible for pulmonary rehabilitation were assigned to the home-based program; they were instructed to complete at least three exercise sessions a week -including aerobic and resistance, segmental strength of upper and lower limbs, and flexibility-; and attend hospital visits every 20 to 30 days; "adherence to the HBP" was determined for patients who attended their final assessment on the fifth visit. A 40.6% (n = 39) of the patients only attended the first visit; 23% (n = 22) adhered to the program. This latter group of patients had shown, at their first assessment, better FVCs (p = 0.013), lower dyspnea scores (p = 0.008), and less than two or more exacerbations during the previous 6 months (p = 0.032). Only one patient needed to take three or more different transportation services to reach the hospital (p = 0.006). The results suggest that adherence to the home-based program was associated to a better clinical status and better access to the hospital.

Desde 1996, el Hospital del Tórax Dr. Antonio A. Cetrángolo aplica un programa de rehabilitación respiratoria, el cual requiere la concurrencia al hospital, dos veces por semana, de los pacientes con enfermedad respiratoria crónica. En 2015, se desarrolló el programa domiciliario (PD) para pacientes que viven a más de 10 km del hospital, o necesitan más de 60 minutos de viaje, o trabajan y tienen incompatibilidad de horarios con el programa hospitalario. Se realizó un estudio retrospectivo con el objetivo de describir la adherencia al programa domiciliario de pacientes con enfermedad respiratoria crónica y explorar los factores relacionados. En 2017, 96 de 127 (75.6%) pacientes elegibles para rehabilitación respiratoria fueron asignados al programa domiciliario y se les indicó cumplimentar al menos tres sesiones semanales de ejercicios de resistencia aeróbica, fuerza segmentaria de miembros superiores e inferiores y flexibilidad; y concurrir al hospital cada 20 o 30 días; a la quinta visita se realizó la reevaluación. Se consideró "adherencia al PD " cuando el paciente completaba la misma. El 40.6% (n = 39) solo asistió a la evaluación inicial y un 23% (n = 22) adhirió al programa. El grupo adherente presentó, al inicio, mejor FVC (p = 0.013), menor score de disnea (p = 0.008), menos de dos o más exacerbaciones en los seis meses previos (p = 0.032). Un solo paciente necesitaba tres o más transportes para llegar al hospital (p = 0.006). Los resultados sugieren que la adherencia al programa domiciliario se relacionó con mejor situación clínica y mejor accesibilidad a la institución.

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Desde 1996, el Hospital del Tórax Dr. Antonio A. Cetrángolo aplica un programa de rehabilitación respiratoria, el cual requiere la concurrencia al hospital, dos veces por semana, de los pacientes con enfermedad respiratoria crónica. En 2015, se desarrolló el programa domiciliario (PD) para pacientes que viven a más de 10 km del hospital, o necesitan más de 60 minutos de viaje, o trabajan y tienen incompatibilidad de horarios con el programa hospitalario. Se realizó un estudio retrospectivo con el objetivo de describir la adherencia al programa domiciliario de pacientes con enfermedad respiratoria crónica y explorar los factores relacionados. En 2017, 96 de 127 (75.6%) pacientes elegibles para rehabilitación respiratoria fueron asignados al programa domiciliario y se les indicó cumplimentar al menos tres sesiones semanales de ejercicios de resistencia aeróbica, fuerza segmentaria de miembros superiores e inferiores y flexibilidad; y concurrir al hospital cada 20 o 30 días; a la quinta visita se realizó la reevaluación. Se consideró "adherencia al PD" cuando el paciente completaba la misma. El 40.6% (n = 39) solo asistió a la evaluación inicial y un 23% (n = 22) adhirió al programa. El grupo adherente presentó, al inicio, mejor FVC (p = 0.013), menor score de disnea (p = 0.008), menos de dos o más exacerbaciones en los seis meses previos (p = 0.032). Un solo paciente necesitaba tres o más transportes para llegar al hospital (p = 0.006). Los resultados sugieren que la adherencia al programa domiciliario se relacionó con mejor situación clínica y mejor accesibilidad a la institución.

Since 1996, the Hospital del Tórax Dr. Antonio A. Centrángolo conducts a pulmonary rehabilitation program that requires patients with chronic pulmonary disease to attend the hospital twice a week. In 2015 the home-based program (HBP) was developed for patients living more than either 10 km or 60 minutes away from the hospital, or with conflicting working schedules. A retrospective study was conducted to describe the adherence to the home-based program by patients with chronic pulmonary disease, and explore adherence-related factors. In 2017, 96 (75.6%) of 127 patients eligible for pulmonary rehabilitation were assigned to the home-based program; they were instructed to complete at least three exercise sessions a week -including aerobic and resistance, segmental strength of upper and lower limbs, and flexibility-; and attend hospital visits every 20 to 30 days; "adherence to the HBP" was determined for patients who attended their final assessment on the fifth visit. A 40.6% (n = 39) of the patients only attended the first visit; 23% (n = 22) adhered to the program. This latter group of patients had shown, at their first assessment, better FVCs (p = 0.013), lower dyspnea scores (p = 0.008), and less than two or more exacerbations during the previous 6 months (p = 0.032). Only one patient needed to take three or more different transportation services to reach the hospital (p = 0.006). The results suggest that adherence to the home-based program was associated to a better clinical status and better access to the hospital.

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OBJECTIVE: To determine associations between home oxygen use and 1-year readmissions for preterm infants with bronchopulmonary dysplasia (BPD) discharged from regional neonatal intensive care units. STUDY DESIGN: We performed a secondary analysis of the Children's Hospitals Neonatal Database, with readmission data via the Pediatric Hospital Information System and demographics using ZIP-code-linked census data. We included infants born <32 weeks of gestation with BPD, excluding those with anomalies and tracheostomies. Our primary outcome was readmission by 1 year corrected age; secondary outcomes included readmission duration, mortality, and readmission diagnosis-related group codes. A staged multivariable logistic regression was adjusted for center, clinical, and social risk factors; at each stage we included variables associated at P < .1 in bivariable analysis with home oxygen use or readmission. RESULTS: Home oxygen was used in 1906 of 3574 infants (53%) in 22 neonatal intensive care units. Readmission occurred in 34%. Earlier gestational age, male sex, gastrostomy tube, surgical necrotizing enterocolitis, lower median income, nonprivate insurance, and shorter hospital-to-home distance were associated with readmission. Home oxygen was not associated with odds of readmission (OR, 1.2; 95% CI, 0.98-1.56), readmission duration, or mortality. Readmissions for infants with home oxygen were more often coded as BPD (16% vs 4%); readmissions for infants on room air were more often gastrointestinal (29% vs 22%; P < .001). Clinical risk factors explained 72% of center variance in readmission. CONCLUSIONS: Home oxygen use is not associated with readmission for infants with BPD in regional neonatal intensive care units. Center variation in home oxygen use does not impact readmission risk. Nonrespiratory problems are important contributors to readmission risk for infants with BPD.

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OBJECTIVE: To characterize home phototherapy treatment for neonatal hyperbilirubinemia and assess the risk factors associated with the need for hospital admission during or after home phototherapy. STUDY DESIGN: This was a retrospective study of newborn infants born at ≥35 weeks of gestation who underwent comprehensive home phototherapy (that included daily in-home lactation support and blood draws) over an 18-month period. We excluded infants who lacked a recorded birth date or time, started treatment at age >14 days, or had a conjugated serum bilirubin level of ≥2 mg/dL (≥34.2 µmol/L). The primary study outcome was any hospital admission during or within 24 hours after completion of home phototherapy. Logistic regression was used to identify risk factors for hospitalization. RESULTS: Of the cohort of 1385 infants, 1324 met the inclusion criteria. At the time home phototherapy was initiated, 376 infants (28%) were at or above the American Academy of Pediatrics phototherapy threshold. Twenty-five infants required hospitalization (1.9%; 95% CI, 1.3%-2.8%). Hospital admission was associated with a younger age at phototherapy initiation (OR, 0.63 for each day older in age; 95% CI, 0.44-0.91) and a higher total serum bilirubin level relative to the treatment threshold at phototherapy initiation (OR, 1.71 for each 1 mg/dL above the treatment threshold; 95% CI, 1.40-2.08). CONCLUSIONS: Comprehensive home phototherapy successfully treated hyperbilirubinemia in the vast majority of the infants in this cohort.

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Objetivo: conhecer a rede de apoio e sustentação dos cuidadores familiares de pacientes em cuidados paliativos no domicílio. Metodologia: estudo qualitativo com registros de 29 cuidadores familiares acompanhados pelo Projeto de Extensão "Um olhar sobre o cuidador familiar: quem cuida merece ser cuidado" de junho de 2015 a dezembro de 2016. As informações de fichas, genogramas e ecomapas foram compiladas em um quadro para quantificação, ou aproximação temática. Resultados: perfil predominante mulheres idosas, cuidando de companheiros, com relação forte com família, programas de atenção domiciliar e paciente e 24 cuidadores tinham algum vínculo fraco com vizinhos, Unidades Básicas de Saúde. Conclusões: a valorização das redes de apoio e sustentação, pensando em ações de melhorias do ambiente de cuidado ao paciente e cuidador podem propiciar um cuidado compartilhado em rede. (AU)

Objective: to know the network of support and sustention of family caregivers of patients in palliative care at home. Methodology: qualitative study with records of 29 family caregivers accompanied by the Extension Project "A look at the family caregiver: who cares deserves to be taken care of" from June 2015 to December 2016. The information of the files, genograms and ecomaps were compiled in a framework for quantification, or thematic approach. Results: profile predominant elderly women, caring for partners, with strong relationship with family, home care programs and patient and 24 caregivers had some weak link with neighbors, Basic Health Units. Conclusions: the valorization of support and sustention networks, thinking about actions to improve the care environment for the patient and caregiver can provide a shared care network. (AU)

Objetivo: conocer la red de apoyo y sustentación de los cuidadores familiares de pacientes en cuidados paliativos en el domicilio. Metodología: estudio cualitativo con registros de 29 cuidadores familiares acompañados por el Proyecto de Extensión "Una mirada sobre el cuidador familiar: quien cuida merece ser cuidado" de junio de 2015 a diciembre de 2016. Las informaciones de las fichas, de los genogramas y de los ecomapas fueron compiladas en un cuadro para la cuantificación, o aproximación temática. Resultados: perfil predominante de mujeres ancianas, cuidando de compañeros, con relación fuerte con familia, programas de atención domiciliar y paciente y 24 cuidadores tenían algún vínculo débil con vecinos, Unidades Básicas de Salud. Conclusiones: la valorización de las redes de apoyo y sustentación, pensando en acciones de mejoras del ambiente de cuidado al paciente y cuidador pueden propiciar un cuidado compartido en red. (AU)

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OBJECTIVES: To identify predictors of home oxygen use in preterm infants with bronchopulmonary dysplasia (BPD) in a statewide cohort, identify hospital variation in home oxygen use, and determine the relationship between home oxygen use and neonatal intensive care unit discharge timing. STUDY DESIGN: This was a secondary analysis of California Perinatal Quality Care Collaborative data. Infants were born <32 weeks of gestation, diagnosed with BPD based on respiratory support at 36 weeks postmenstrual age (PMA), and discharged home. Risk factors for home oxygen use were identified using a logistic mixed model with center as random effect. Estimates were used to calculate each center's observed to expected ratio of home oxygen use, and a Spearman coefficient between center median PMA at discharge and observed and expected proportions of home oxygen use. RESULTS: Of 7846, 3672 infants (47%) with BPD were discharged with home oxygen. Higher odds of home oxygen use were seen with antenatal steroids, maternal hypertension, earlier gestational age, male sex, ductus arteriosus ligation, more ventilator days, nitric oxide, discharge from regional hospitals, and PMA at discharge (receiver operating characteristic area under the curve 0.85). Of 92 hospitals, home oxygen use ranged from 7% to 95%; 42% of observed home oxygen use was significantly higher or lower than expected given patient characteristics. The 67 community hospitals with higher observed rates of home oxygen had earlier median PMA at discharge (correlation -0.27, P = .024). CONCLUSIONS: Clinical and hospital factors predict home oxygen use. Home oxygen use varies across California, with community centers using more home oxygen having a shorter length of stay.

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